Pre-clinical atherosclerosis is found at post-mortem, in the brains of men with HIV
Daramola, Olusola Ali, Hebah Mckenzie, Chris Anne Smith, Colin Benjamin, Laura A. Solomon, Tom
The aim of this study is to ascertain the burden of pre-clinical atheroscleroticchanges in the brains of young adult males with HIV and explore the impact ofanti-retroviral therapy (ART). The study design is case-control, cross-sectional. Histological sections from HIV-positivepost-mortem brain samples, with no associated opportunistic infection, from theMRC Edinburgh brain bank were evaluated. These were age and sex matched with HIV-negativecontrols. Immunohistochemical stains were performed to evaluate characteristicsof atherosclerosis. The pathological changes were graded blinded to the HIVstatus and a second histopathologist reassessed 15%. Univariable models wereused for statistical analyses; p≤0.05 was considered significant.Nineteen HIV-positivepost-mortem cases fulfilled our inclusion criteria. Nineteen HIV-negativecontrols were selected. We assessed mostly small-to medium-sized vessels. For inflammation (CD45), 7 (36%) of the HIV+ had moderate/severe changes compared withnone for the HIV− group (p<0.001). Moderate/severeincrease in smooth muscle remodeling (SMA) was found in 8 (42%) HIV+ and 0 HIV− brains (p<0.001).Moderate/severe lipoprotein deposition (LOX-1) was found in 3 (15%) and 0 HIV−brains (p<0.001). ART was associated with less inflammation [5 (63%) noART versus 2 (18%) on ART (p=0.028)] but was not associatedwith reduced lipid deposition or smooth muscle damage. InHIV infection, there are pre-clinical small- to medium-sized vesselatherosclerotic changes and ART may have limited impact on these changes. Thiscould have implications on the increasing burden of cerebrovascular disease inHIV populations and warrants further investigation.
Journal of NeuroVirology
1. Patient Research for Public Health